A while back I had just started acting as charge nurse on night shift, I walked in at the start of my shift to see we were horrendously short staffed and crazy busy. Our unit was well below our usual staffing grid (it was a Friday night)... we also had a full board... full triage... and not enough nurses to go around.
It was dangerously busy... and one of the pieces of advice we got from the nurse supervisor was to "think outside the box" to handle the short staffing issue.
What did that mean!? I needed nurses... I needed less patients... but neither of those things was going to happen, no matter how hard I cried inside.
A few years later, I can snicker at the idea of "thinking outside the box" when I have to handle nights like that one... but ultimately that's where the inspiration for this post came from.
Shifts like the one I had that night happen all too common on hospital units and it can cause unsafe patient assignments, staff burnout, and patient dissatisfaction. As Charge nurse I've had to "think outside the box" in order to maintain control of a short staffed unit.
Read on for some strategies on dealing with short staffing on a busy hospital unit.
Enlist your Manager/Nursing Supervisor:
Always let your manager know if you have an unsafe staffing situation. In most hospitals, nurse managers are required to be on call 24/7 to help deal with issues, like staffing, and provide assistance if able.
Larger hospitals actually have nursing supervisors who oversee each patient unit and it's workflow while being in house. During times of need, your nursing supervisor/manager may offer you a float RN or additional staff. Call management to do some of the legwork for you.
Prioritize, Prioritize, Prioritize!!
When you are scraping the bottom of the barrel with staff, some things will have to be put on the back burner. Patient safety is above all things the most important.
Prioritize your care to address immediate needs of patients that will directly effect their safety and well-being. Monitoring of vitals, lab draws, medication passes, and proper assistance with toileting are among the most important issues.
Discharge planning and patient education may need to be postponed until reinforcements arrive. If you do have to delay certain aspects of care, pass the information along so the next shift can make sure all the patient needs are met.
Utilize Support Staff
Get creative and utilize support staff, apply teamwork, and effective communication. Have secretaries make phone calls to bring in staff and make sure PCT's know to work together to keep patient's needs met.
You can also enlist physicians and residents to help with turning/boosting in bed if you see that they are rounding and available for a quick assist. An effective unit has to work together and ditch the mentality of "not my job," especially during a time of poor staffing.
Clear Out Patients:
Do you have a patient whose status has improved and is no longer needing a higher level of care that an ICU or step down unit provides? Maybe your patient is off telemetry and can transfer to another floor with better staffing and more available resources. Consider transferring appropriate patients, contact your nursing supervisor or bed management for assistance with arranging transfers.
Also, consider last minute discharges, when patients request an early discharge they may be accommodated if their physician's orders deem it's medically appropriate.
Call the Staffing Office:
If you haven't all ready, use the staffing office to send out an S.O.S. for more help. It is usually in the form of a mass text to the employees that the shift pertains to. Sometimes this simple task can help fill holes in staffing if nurses are looking for extra hours.
Make it Known:
As nurses, we have to protect our licenses and work to ensure that short staffing is not the norm but a rare occurrence. When a unit I've worked on has been short staffed to the extent that I've felt unsafe providing care, I have filed incident reports and sent emails to my managers, especially for off-shift nurses.
Letting management know can help see and prepare for the need for increased staffing during patient surge times or learn how to address short staffing in the future.
Don't be too hard on yourself, if you prioritize your care, apply teamwork, and effective communication you and your staff will get through a short staffed shift.
Take a deep breath, grab a break when you can, and do your best... there are many reasons why a unit may not be staffed appropriately. Part of nursing is being able to go with the flow, roll with the punches, and keep your head up!
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